Month: July 2010

I sat down this week with Amber Hansen, the new Nutrition Works Coordinator, to chat about the program and why diet is so important to providing your immune system and physical health with maximum support. Nutrition Works is open to BLC members with an income of $992/month or less and it is one of the most utilized programs the BLC runs

J: Members who participate in Nutrition Works love the program, but those who aren’t involved might not have a sense of its purpose and how it works. Could you give us an overview?

A: Nutrition Works is a collaboration between the BLC and the American Red Cross of Massachusetts Bay at their center Wednesday and Saturday 1:30-3:00. The program is available for members based on income and it allows members to come to the pantry to pick up groceries and, at the same time, attend a workshop with a nutrition focus. I’ve taught the workshops the past few times, but dietetic interns will lead a couple of them, so there’s some mixing up, which I always think is nice. I’m trying to keep the workshops seasonal, so I did one on exercising in the heat and good hydration. I’m going to do one on farmers’ markets and how to access them if you’re on food stamps.

I want the workshops to be targeted to low income individuals. There are so many important issues to address- how to prevent food spoilage to make food last longer, specific recipes to work with bulk items you’ll be getting at the pantry every time, how to find the best deals on healthy food when you’re working on a budget.

The goal of the program is to give people healthy food and provide workshops to explain the rationale behind that.

J: It sounds like Nutrition Works is trying to think beyond just providing food and provide the right kind of food. There are some general rules of thumb for healthy eating, but when you’re thinking about nutrition for someone who is HIV-positive, what specific issues would you address?

A: There are all sorts of issues that affect someone’s health: their HIV status, social history, access to food, income level, literacy level if I’m providing educational materials that are written. You have to consider the big picture when you’re thinking about what would be best for someone’s nutrition and overall health.

Some people may be dealing with wasting syndrome and need to consider weight management. Bone health and dental health have a large impact. Then people have questions about supplements and food-medication interactions. Medications have side effects—loss of taste, gastrointestinal problems like diarrhea, metabolic complications—and those affect nutrition. Lipodystrophy, a redistribution or build-up of fat, can be a concern for people. You can’t always change that with nutrition, but it’s good to think about, because the fat affects insulin (your ability to regulate blood sugar). Heart disease is also an issue where a lot of research is emerging. It’s important to keep up, because research is always changing and we’re learning new things

J: People may be worried that they don’t have enough cooking skill, time or energy to prepare meals at home. Does the program address that concern?

A: The hope is that we’ll do that by providing recipes specific to food we’re giving out. Recipes that people can actually use. A couple members who have a lot of cooking skill themselves have suggested making a cookbook with recipes they’ve created. Putting together something to hand out would be great.

The reality of the food system the way it is means that people eat a lot of processed food and we give some of that out. Canned vegetables are convenient, but a tip with that would be to wash them off first because they can be really high in salt. Luckily we have the option to give out fresh stuff too. The Canned Food Alliance website has a lot of recipes and a healthier take on using canned food.

One of my goals for the summer is to restart the Operation Frontline classes. They’re six week sessions of classes where people get a bag of food based on recipes we use in the class. They’re super easy recipes and people can take them to use with the food when they get home. The sessions are co-led by a chef and a dietitian, so I would teach about nutrition and the chef would pass on the cooking skills

J: Many AIDS service organizations have been expanding their prevention, treatment, and care plans to fully address the interplay of aging and the various stages of HIV. When you think about nutrition for HIV-positive people, how does age factor into the equation?

Because medicine has progressed, people are living longer, which presents new challenges. I’m counseling patients who are facing chronic illnesses like high blood pressure, cholesterol, diabetes, illnesses that weren’t always as relevant to this population. There used to be an exclusive focus on nutrition to deal with wasting syndrome; people were just trying to put on as much weight as possible. But now they’re facing chronic illnesses and that requires a more complex nutrition plan to address healthy living as a daily practice.

J: Sometimes a lot of educational information can be overwhelming. Could you offer some key take-away points for people to consider when thinking about their nutrition?

A: I feel like nutrition is so specific to the person and I really like to meet people where they are in terms of making nutrition changes. Not everything’s going to work for everyone. In general I’d encourage the basics: a healthy diet, but enjoying the food that you eat, and balancing that out with some kind of physical activity. That will help with weight maintenance, but it also releases endorphins to keep you happy.

Fruit and vegetables are important and Americans tend to be pretty bad about getting enough of them. Of course, your access to fruit and vegetables can be income dependent, but there are many forms you can find them in. I’d emphasize that you can make positive changes on a budget.

J: Thank you so much! Any last words you’d like to share about the Nutrition Works program or nutrition more generally?

A: Anyone interested in Nutrition Works can come fill out an intake with me or another staff member in Member Services. It really is a great program, because you not only get healthy food, you also get the skills and recipes in the workshops to use the food in everyday life. Changing habits is hard. The pantry provides a structural change (the food’s great!), but we’re also there with people to help them change their habits.

Public health education about HIV and IV-drug use must be expanded beyond risks of transmission. While researchers promote more comprehensive, lifestyle-oriented models for studying HIV/AIDS, many continue to isolate the topic of crystal meth use to conversations around primary prevention. HIV positive people face considerable health risks if they are crystal meth users, and information about those affects should be more widely circulated.

A 2007 report from the Multicenter AIDS Cohort Study showed that men using meth and poppers who had unprotected receptive anal sex with one partner had a 2.71risk rate relative to men who didn’t use the drug; men who had unprotected sex with 5+ partners had a 13.57risk rate.[1] This study leaves too many variables unaddressed to conclude meth diminishes CD4 count or speeds up HIV replication, but scientists analyzing the interaction between meth and HIV at a chemical level have supporting evidence.

In 2009 a New York-based research team explored the effect of meth on the rate of HIV replication and determined that while further tests must be done, crystal does appear to hasten the progression of HIV. Adding meth to test tubes with immune cells produced a marked increase in HIV replication, particularly in CD4 cells. When HIV-infected mice were given crystal, a segment of the HIV genetic code was switched on and began producing tumor necrosis factor alpha, a protein linked to accelerated HIV disease progression.[2]

Some speculate that the correlation between meth use and increased HIV disease progression is due to lifestyle factors. Meth users may have more difficulty sleeping, eating properly, or maintaining a routine.[3] A decline in healthy living habits has been linked to weakened immune system and may contribute to accelerated HIV progression. An additional component of living healthy with HIV is commitment to medication. Users who have difficulty following a schedule may struggle with adhering to their medication regimen and compromise their health in this way.

Crystal meth use compromises healthy living practices and recent research suggests that crystal may have a direct influence on the rate of HIV replication. It is, therefore, important for anyone who is HIV-positive and currently using crystal to address risks with a healthcare provider. If you are HIV-positive and want to reduce or stop your crystal meth use, you’re in the right city! Many organizations in the Greater Boston area provide assistance with addiction and several have distinguished themselves for attentiveness to the needs of HIV+ people:

Fenway Health offers acupuncture detox and multiple support groups, as well as their New Champions program which provides peer support and referral services to gay and bisexual men struggling with meth addiction.

Victory Programs offer a range of recovery services with a focus on residential alcohol and addiction treatment programs.